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Insect Bite Avoidance

Vectors are living organisms that  transmit infectious diseases between humans or from animals to humans. They are mainly insects or ticks. When feeding on human blood, vectors such as mosquitoes, ticks, sandflies, fleas, blackflies, tsetse flies and reduviid bugs can transmit dangerous disease causing parasites, viruses and bacteria.

Globally vector-borne diseases cause over 700 000 deaths annually and the burden of these diseases is highest in tropical/subtropical areas which travellers may visit. Destination specific information can be found on individual country pages.

Insect and tick bite avoidance should always be considered as the first line of defence against these vector-borne diseases.

Additionally, insect and tick bites can produce discomfort and irritation to the skin and may become infected, often through scratching. Information on treating insect bites can be accessed here.

Mosquitoes

Mosquitoes are found worldwide and transmit a variety of infections, depending upon the mosquito species and geographical area. 

Detailed guidance on mosquito bite prevention is found on the Mosquito Bite Avoidance page.

Ticks

The bite itself may be itchy and could cause redness in surrounding skin, particularly if the mouth parts are incorrectly removed. Very rarely muscle weakness or paralysis may occur due to a toxin in tick saliva – removal of the tick helps these symptoms resolve.

Ticks are generally found in woodland, overgrown fields, parkland, hill and mountainsides. They normally become attached to skin or clothing after a person has brushed against bracken or long grass and then crawl to find warm moist areas of the body such as groins or armpits to feed.

Tick Bite Avoidance:

  • Avoid unnecessary exposure in infested areas, keep to clearly defined paths to avoid brushing against vegetation where ticks may be present.
  • Wear long sleeved tops, trousers and shoes, and tuck trousers into socks to reduce the amount of exposed skin that could be bitten. 
  • Wearing light coloured clothing makes ticks more visible if they brush onto clothing.
  • Clothing, footwear and camping gear can be impregnated with permethrin (insecticide) to increase protection against tick bites. Permethrin products are available in sprays and wash-in formulas and can remain protective through several washes. Manufacturers guidelines should always be followed.
  • Use insect repellents containing DEET, picaridin, IR3535 or Oil of Lemon Eucalyptus on exposed areas of skin.
  • Clothing and skin should be examined for ticks at the end of the day; if found they should always be removed as soon as possible.

Removing a Tick:

  • Ticks can be removed using specially designed hooks/cards, or with tweezers. The tick should be grasped as close to the skin as possible and gently but firmly pulled upwards. 
  • Avoid crushing or squeezing the tick with bare hands.
  • Do not use any products such as petroleum jelly, alcohol, nail polish remover, or lit matches to try and remove a tick as this can cause it to regurgitate infectious material into bite.
  • After removing the tick, clean the bite area and your hands with soap and water or alcohol gel.

Sandflies

  • Sandflies are the vector of leishmaniasis.
  • These are tiny (3.5mm), sand coloured flies found in tropical and warm temperate regions worldwide.
  • Sandflies bite from dusk to dawn or during the day if disturbed. The bite itself is often very itchy.

Sandfly Bite Avoidance:

  • Avoiding outdoor activities after dusk where possible.
  • Cover skin with clothing where possible.
  • Consider permethrin impregnation of clothing when outdoor activity is unavoidable.
  • Use insect repellent e.g. DEET on exposed skin.
  • Sleep under insecticide-impregnated bed nets (fine mesh size is required) or in air-conditioned rooms.
  • Sandflies are weak fliers, using fans/ventilators disrupts their movement and sleeping elevated from the floor reduces their ability to reach you.

Fleas

Rat fleas are the vectors of plague in humans. As the name suggests, rat fleas live mainly on rats but can also live on other small animals and rodents, they can hide in beds and bed clothing and are found in tropical areas where sanitation is poor.

Flea Bite Avoidance:

  • Use insect repellents (e.g. DEET 50%, picaridine, IR3535) to avoid flea bites.
  • Practice good hand hygiene (e.g. handwashing, use of soap or alcohol solutions).
  • Avoid contact with rodents, sick or dead animals.

Blackflies

Blackflies are the vector of river blindness (onchocerciasis). The bite itself may cause itchy clusters of red bumps. Blackflies typically bite during the day.

Black fly Bite Avoidance:

  • Covering up with clothing reduces the amount of skin that can be bitten i.e. high necked clothing with long sleeves and trousers or long skirts.
  • Clothing can be thin, loose and light weight in hot environments.
  • For added protection, clothing can be impregnated or sprayed with pyrethroid insecticides such as permethrin. Manufacturers’ guidelines should be followed. Frequent washing of these garments will reduce the insecticides effectiveness.
  • Exposed areas of skin should be covered with an insect repellent such as DEET.

Tsetse flies

Tsetse flies are the vector of sleeping sickness (African trypanosomiasis).  Tsetse flies are only found in sub-Saharan Africa. Rural populations which depend on agriculture, fishing, animal husbandry and/or hunting are the most exposed to the tsetse fly and therefore to sleeping sickness. Travellers to known risk areas that plan to spend a lot of time outdoors or who go to game parks are at increased risk.

Tsetse fly Bite Avoidance:

  • Covering up with clothing reduces the amount of skin that can be bitten i.e. high necked clothing with long sleeves and trousers or long skirts.
    • Clothing should be made from medium weight fabric because the tsetse fly can bite through thin fabric.
    • Clothing should be neutral-coloured; tsetse flies are attracted to bright colours, very dark colours, metallic fabric, and the colour blue.
    • Clothing can be impregnated or sprayed with pyrethroid insecticides such as permethrin. Manufacturers’ guidelines should be followed. Frequent washing of these garments will reduce the insecticides effectiveness.
  • There is limited evidence to support the use of insect repellents against tsetse flies, however, an insect repellent such as DEET should be used on exposed skin.
  • Tsetse flies are less active during the day, they rest in bushes and will bite if disturbed. Bushes are therefore best avoided.
  • Accommodation should be screened or air conditioned rooms.

Reduviid Bugs (Triatomine bugs, Kissing Bugs, Assassin Bugs)

Chagas disease (American trypanosomiasis), is parasitic disease which is mainly transmitted by contact with faeces/urine of infected Reduviid bugs. Reduviid bugs usually live in the wall or roof cracks of poorly-constructed homes; they hide during the day and become active at night when they feed on human blood. They usually bite an exposed area of skin such as the face, and defecates close to the bite. The parasites enter the body when the bugs faeces or urine are inadvertently rubbed into the bite or mucous membranes.

Reduviid Bugs Bite Avoidance:

  • Avoid sleeping in buildings with unplastered straw or adobe walls or when there are cracks or holes in the walls or the plaster.
  • Use a bed net impregnated with a pyrethroid insecticide such as permethrin.
  • Clothing, footwear and camping gear can also be impregnated with a pyrethroid insecticide such as
  • If feasible treat accommodation and surrounding areas with residual insecticides.

Treating Insect Bites

Apart from acting as vectors of disease, insect bites can result in unpleasant and occasionally serious skin reactions.

Usually no treatment other than simple first aid is required:

  • If a stinger is visible in the skin - remove it as quickly as possible by scraping sideways with a fingernail, a piece of card or a credit card.
  • Clean the area with soap and water, alcohol gel or antiseptic; secondary infections may be avoided with good hygiene and avoidance of scratching itchy bites.
  • The use of cold compresses may help reduce local pain, swelling and itching.
  • Oral antihistamines such as chlorphenamine (sedating) or topical corticosteroids (such as hydrocortisone 1%) may help reduce itching.
  • Seek medical advice if there is worsening redness, pain, fever, a large skin reaction or prolonged healing (over 2 weeks).

Resources

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